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Claims Management ProgramDay One ABLE Claims Administrator Training
November 2014
ABLE Assessor Training
Claims Administrators Training Program
2 |
Timing Day One Job Aid Slide no
09.00 – 09.20 Introduction, & Housekeeping
09.20 – 09.30 Learning Outcomes / Content Covered / Module Format PowerPoint Pack
09.30 – 09.45 Introduction to Claims Management Program PowerPoint Pack
9:45 – 10:00 Log in (Able and EDGe)
10:00 – 10.15 Navigating the Able Claims Management System Navigation
10.15 – 10.30 Break
10.30 – 11.30Navigating the Able Claims Management System cont.
(Status Flow, Tasks)
Navigation
Tasks
11.30 – 12.30 Sending Claim Forms Outbound
Correspondence
12.30- 01.30 Lunch
01.30 – 02.30 Managing Concurrent Claims Concurrent
Claims
2:30 - 3:00 Index Inbound DocumentsInbound
Correspondence
03.00 – 03.15 Break
03.15 – 04.30 Recap & Final Questions
ABLE Assessor Training
Claims Administrators Training Program
3 |
Timing Day Two Job Aid Slide no
09.00 – 09.30 Refresh
09.30 – 10.15 Payment Creation Payments
10.15 – 10.30 Break
10.30 – 11.30Payment Letter Creation and Forms
Payments
11.30 – 12.30 Payment Authorisation Payments
12.30- 01.30 Lunch
01.30 – 02.30 Payment Expenses Payments
02.30 – 03.30 Workarounds Payments
03.00 – 03.15 Break
03.15 – 04.30Recap, Quiz, Final Questions
Evaluation
4
Part 1 Context / High Level Process
• Learning Outcomes
• Context / scenario setting
• High level process overview
Part 2 System demonstration and practise
• Process demonstration and practise
• Process variations and practise
Part 3 Consolidation activities
• A series of practical activities for you to complete
.
What each module will cover
5
The Claims Platform Claims Administrator course will take you through the use of the new ABLE Claims Platform system, claim, customer and workflow management functionality.
By the end of this session you will be able to:
• Navigate, search and enter transactions in ABLE
• Send Claim Forms
• Manage Concurrent Claims
• Index Inbound Documents
• Process Payments
What you will learn
Introduction to the Claims Management Program
6 | ABLE Administrator Training
Understand what the Claims Management Program is and how Able fits into it
Customers are not supportive of the insurance industry as a whole
Confusion ReignsInsurance and finances are difficult to understand and hard to keep track of
The game you never winLife insurance is a lose-lose game. Either something terrible happens, or you never get any tangible benefit form your policy
The gambleIronically, relying on insurance induces more anxiety than it offers peace of mind
Insurance is replaceablePeople perceive life insurance to be replaceable with other sources of cash such as property or savings
Protect (me from) my familySome people saw insurance as a means to protect their family; others saw it as a way to help them maintain independence
My life changes, insurance doesn’tPeople’s lifestyles, worries and financial needs change over time, while insurance premiums only go one direction: up
You handle itReally good services go beyond cutting a cheque; it takes stuff off people's plates
ReciprocityTrust can only be attained through proof of experience.
Feel flexible; be flexible People want to know and feel like their options are editable as they move through life
Wellness includes financial healthPeople believe holistic health encompasses physical, emotional, and financial well-being
Simplicity is everythingIn the confusing world of financial products, less is more
LEARNING INSIGHTS RESONANCE INSIGHTS
Through talking with consumers, we came to understand what people really thought about Insurance…
• Page 7 |
Tagline or document title
How does the Able fit in with what else is happening?
8 |
Case reviews
Working with Banyan Health Solutions and ICS to undertake targeted case reviews.
Looking at ways to achieve positive outcomes for both AMP and our customers.
Pilot
Trial our new Claims Approach and ensure we deliver on our customer experience. Learn from our experience and refine the design of the workflow, policies, processes and tools.
Trial new roles to help us determine the capabilities we need to build across our business – knowledge, skills, attributes.
Able Platform
Implement our new Claims Platform to provide:
• Single claims platform for all products within AMP
• Better visibility of whole customer profile – open claims, claim history
• Collaborative approach to managing claim across AMP
• Future ability for external parties to access claim info via portal.
AMP has embarked on a multi-year journey to design and embed a new approach to claims management
Phases2014:
Confirm our strategy and
objectives. Design and pilot a model
which will deliver a new customer
claims experience.
Phase 1 Phase 2
2016Ensure the new claims approach
is successfully embedded and remains sustainable.
Evolve and continuously improve the claims experience thorough feedback
and review.
Strategy and model to deliver a new customer claims experience confirmed
Collaborate and refine approach with a broad range of internal and external
stakeholders
2015: Invest and implement new
technology and carry out extensive training to support the delivery of
a new customer claims experience.
• Page 9 |
The Claims Program has three key areas to enhance customers’ and advisers’ claims experience
We are here
Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015
Enable the Business with a new technology Platform
Establish the foundation Design the new Deploy the new Transition and Embed
Drive Cultural, People Capability and Case Management process change
Deliver immediate improvements to AMP claims experience. Test and refine our new Claims Approach through file reviews
1
2
3
Foundation
Model
Platform
Q3 2015
• Page 10 |
Tagline or document title
Benefits of Able
• Integration with CRM (Customer) and PAS (Policy)records
• Claim Number allocated from notification stage
• Virtual file replaces paper file
• Online access to single claim file, by multiple users
simultaneously
• Workflow drives process (some manual intervention)
• Tasks can have SLAs associated with them
• Outbound correspondence created, indexed and stored
within Able
• Inbound documents indexed and stored for retrieval in Able
• Intelligent reporting and analytics
11 |
Claims Philosophy
Retail IP Products in scope for Release 1
12 |
IP
• IPA• IPB• IPC• IPD• DII• RDI• RII
TSC
• SCG• SCI• TSC• TIP• TI2• TI5
BOI
• BEC• RBE• RBEN
13 | ABLE Assessor Training
Able Claims Management System
A demonstration of the key features and applications of Able
Tagline or document title 14 |
Log in to the Able training environment using your LAN ID & Password
To Log in:
Enter http://claims.com.au/FINEOS772 in a browser.
The login screen displays
Enter your Username and Password
Click Login
Log in (Able and EDGe) Activity
Refer to Job Aid: Navigation
15 |
Navigating the Able Claims Management System Glossary
What ABLE terms will be new to you?
Refer to your Navigation Job Aid Glossary.
Let’s discuss the meanings of the following terms…
Claim System
Party Widget
Participant Tab
Case Task
Sub Case Managed Requirement
Claim Status
Benefit Process
eForm
Validation
Refer to Job Aid: Navigation
Pilot Onboarding v2.0 – Group IP 16 |
Let’s take a break
Tagline or document title
Navigating the Able Claims Management SystemActivity
You will be provided with some Case ID’s and other information to help you navigate and practise moving around the Able system.
17 |
• Home Screen• Party / Claimants / Cases and other Data• Case and Associated Tabs• Tasks, Validation and Managed Requirements• Able Workflow Process Tool
Tagline or document title
TasksActivity
18 |
A Task is a work item that Team Leaders route to a user’s work queue for completion. All work belonging to a user displays in work queues.You can also pull down tasks to your queue using the Get Next Task button.The different types of tasks are represented by Task Types.
Refer to Job Aid: Tasks
A task can have the following status:Open: An Open task is a task that you can editOn Hold: An On Hold task is a task that a user has chosen to suppress because the user cannot immediately perform the taskClosed: A Closed task is a task that has been completed and you cannot edit.Cancelled: A Cancelled task is a task that was created in error and does not display in the work queue
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 1
19 |
Where do you click to activate a second Able session?
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 1 Answer
20 |
Where do you click to activate a second Able session?
A: Click the icon in the top right hand corner
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 2
21 |
How do I search for a case?
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 2 Answer
22 |
How do I search for a case?
A: Open Case / Existing Case Tab / Enter Case No / Search
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 3
23 |
Where would you go to see your tasks?
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 3 Answer
24 |
Where would you go to see your tasks?
A: The My Tasks Tab
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 4
25 |
How do I go home?
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 4 Answer
26 |
How do I go home?
A: Click the House Icon in the top left hand corner
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 5
27 |
How do I search for a claimant?
Pilot Onboarding V1.0 – Retail IP
Pop Quiz Question 5 Answer
28 |
How do I search for a claimant?
A: Select Open Party / Enter Claimant’s Last Name & DOB or Last Name & Policy
29 |
Send Claim FormsHi-level Process
As a Claims Administrator you will receive the Issue CA- Issue Claims Forms task from a Claims Assessor , including instructions related to sending the party forms and letters as required.
1. Open CA-Issue Claims Forms task from queue
2. Review Assessor
Instructions
3. Validate party details
4. Complete EDGe steps to generate
letter
5. Complete interview now
(Inow) questions
6. Preview the letter
7. Edit the letter
8. Quality check the
letter
10. Close Issue Claims Forms task
9. EDGe Submit the
letter
Send Outbound Correspondence including forms and letters to Customers to Request Initial Claim
Forms.
Refer to Job Aid: Outbound Correspondence
Tagline or document title 30 |
• We will now demonstrate in the system an example of Actioning the CA-Issue Claim Forms task starting by going to our Tasks queue and open the Task.
Action CA-Issue Claim Forms task
Send Claim FormsActivity
• You can now have a go yourself starting by going to your Tasks queue and open the CA-Issue Claim Forms Task.
Pilot Onboarding v2.0 – Group IP 31 |
Let’s take a break
Tagline or document title 32 |
Manage Concurrent ClaimsHi-level Process
1. Check policy details in CRM, Figtree & Able
2. Complete Claim intake for both claims in Able
3. Add Figtree details to Issue
Claims Form task
4. Team Lead allocates Issue Claim Form task to Admin
Stage One – Claims Assessor
This is what the Claims Assessor will have done to prepare the work before it comes to you
A customer has called the Claims Assessor. The customer has IP and TPD policies with AMP. The customer wants to claim against their IP and TPD policy. IP is supported in the Able system, whereas TPD is supported by Figtree. The Assessor will now need to manage these claims concurrently in Able and Figtree.
Refer to Job Aid: Concurrent Claims
Understand how to concurrently manage Income Protection Claims in Able and TPD Claims in Figtree
Tagline or document title 33 |
Manage Concurrent ClaimsHi-level Process
1. In Figtree set up Able case
reference
2. In Able add Figtree number to the General
Description field
3. In Able select Initial Claim Form document
and confirm correspondence
4. In EDGe amend letter to add Figtree
reference and selected forms
5. In Figtree create required Figtree form and overwrite the Figtree claim no. with the Able
case no.
6. Post Initial Claim Forms
7. In Able close the Initial Claim
Form task
Stage Two – Claims Administrator
Trigger : Your Claims Admin Team Leader issues the CA-Issue Claims Forms task to your work queue…
Tagline or document title 34 |
• We will now demonstrate in the system an example of actioning the CA-Issue Claims Forms task.
• You will receive this task in your work queue. To open it, double click and then click on the case hyperlink to open the case.
Action open the CA-Issue Claims Forms task
Manage Concurrent ClaimsActivity
• Have a go yourself starting with going to your work queue and opening a CA-Issue Claims Forms task.
Tagline or document title 35 |
Manage Concurrent ClaimsHi-level Process
1. Backscan Figtree forms to the case that came in
via internet mail
2. Manage requirements 3. Initial Assessment
4. Accept Benefit / Accept Benefit with Committee Review
5. Update Figtree claim and raise Payment task
Stage Three – Claims Assessor
Once you have closed the Initial Claims form task, the Assessor can action the following…
Tagline or document title 36 |
Manage Concurrent ClaimsHi-level Process
1. Set up Payment / Payment letter for
Figtree claim
2. Close Figtree claim
1. Payment Creation
2. Payment Authorisation
Stage Four A&B – Claims Administrator
Stage Four A
Stage Four B
Trigger : Once the Claims Assessor issues the Payment task, your Admin Team Leader will allocate the Payment task in Figtree.
Pilot Onboarding v2.0 – Group IP 37 |
Let’s take a break
38 |
1. From the My Tasks indexing
queue you can Get Next Task
2. Select Do Task, the Indexing Service
screen displays
3. To open the document, select
Open Images
4. Search for case and attach the imaged docs
Index Inbound Documents Hi-level Process
5. Claim Number auto
populates
6. Nominate the doc type i.e. AMP. Initial
Claim Form, Inbound
7. Enter Doc Title and
description
8. Doc is now attached to the claim
Refer to Job Aid: Inbound Correspondence
Indexing unclassified documents in Able
Tagline or document title
Index Inbound DocumentsActivity
39 |
• We will now demonstrate in the system an example of actioning the Document Unclassified task
Indexing documents in Able
• Have a go yourself
End of Module
ABLE Claims Assessor Training 40 |